Patient Forms

For your convenience, we've provided our patients forms on our website.

If you choose to fill out the patient form packet at our office, please arrive 10-15 minutes before your appointment to allow enough time to get them completed before your appointment.

Our forms are PDF files. In order to download and print them, you'll need the free Adobe Acrobat Reader program: iPad/iPhone | Android | Desktop

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• FOR ALL PATIENTS: : Print, fill out and bring in the "Patient Registration," "Medical Intake" and "Patient Responsibility and Privacy" pages. Then just view or print the other three as desired.

• Patient Registration
• Medical Intake
• Patient Responsibility and Privacy
• HIPPA
• BPTW No Show / Late CX Policy
• BPTW Facility Guidelines
• Self-Pay Info

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• OUTCOMES - print specific form(s) as directed by BPTW

• Dizziness Handicap Inventory
• Knee Survey
• QuickDASH / Upper Extremities
• LEFS
• Back
• Neck Index
• Falls Efficacy Scale
• Foot & Ankle Measure

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• AS NEEDED

• Auto Non-Work Accident Form
• Direct Access Patient Attestation
• Records Release Form

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• TMJ

• TMJ Functional Index
• TMJ Discomfort Scale

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• LASER

• Laser Therapy Agreement
• Laser Medical Intake